Customer Service Representative

Medical Customer Service Representative

We are looking for a dedicated and detail oriented Medical Customer Service Representative. This role requires exceptional communication skills and the ability to work effectively in a fast-paced, high-volume call center environment, particularly within the healthcare industry. As a contract to permanent position, this opportunity offers the potential for long-term placement based on performance.

Responsibilities:

• Respond promptly and courteously to customer inquiries regarding medical benefits, eligibility, claims, and provider information.
• Assist customers in resolving pre-authorization requests for medical treatments and provide accurate information about outstanding payments.
• Document interactions and track call details using internal systems to ensure proper record-keeping.
• Stay informed about company policies and updates to healthcare plans to provide accurate and current information to customers.
• Handle complaints, troubleshoot issues, and escalate complex cases to supervisors when necessary.
• Deliver high-quality service by adhering to scripts and guidelines while maintaining a friendly and detail oriented demeanor.
• Educate customers about network providers and guide them through available options.
• Collaborate with team members to improve processes and ensure customer satisfaction.
• Comply with HIPAA regulations and follow standard precautions for personal protective equipment when required.

Requirements:

• Strong background in call center operations, especially in healthcare-related settings.
• Familiarity with medical terminology, diagnosis codes, and insurance protocols.
• Excellent verbal and written communication skills with an ability to handle challenging situations calmly and effectively.
• Proficient in computer systems and Microsoft Outlook with a fast typing speed.
• Demonstrated ability to think critically, make sound judgments, and manage stress in high-pressure environments.
• Availability to work flexible shifts, including evenings, weekends, and holidays.
• Associate's Degree preferred; alternatively, 1-3 years of healthcare customer service experience in a call center setting is acceptable.
• Previous experience as a Customer Service Specialist or equivalent role is required.